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Surgery plays an important role in the management of advanced stage ovarian cancer and is complex involving surgical procedures including peritonectomy, splenectomy, diaphragmatic stripping, retroperitoneal lymph node dissection and bowel resection including resection of recto-sigmoid.  Objective: To assess the safety and efficacy of the patients undergoing modified posterior pelvic exenteration and rectosigmoid anastomosis achieving in optimal cytoreduction.  Methods: Between June 2011 and June 2014 a total of 100 patients underwent surgical cytoreduction for advanced epithelial ovarian cancer of which 20 patients had undergone modified posterior pelvic exenteration with rectosigmoid anastomosis. The present study includes a retrospective analysis of these 20 patients. Rectosigmoid anastomosis was done using circular stapler in these patients. All patients had a PS score of 1 or 2.  Results: The median age of patients was 50 years. The optimal status of no macroscopic residual disease was achieved in all patients. Modified posterior pelvic exenteration with rectosigmoid anastomosis was carried out to achieve optimal status of surgical cytoreduction in 20 patients out of which fifteen patients had primary surgical cytoreduction, three patients had interval surgical cytoreduction surgery after receiving three cycles of neoadjuvant chemotherapy with paclitaxel &amp; carboplatin while two patients had this procedure as a part of secondary surgical cytoreduction. The most common histology was papillary serous carcinoma. Average blood loss was 500 ml. Mean operative time was 6 hours. There were no intra operative complications. Bowel movements returned to normal in 3 to 5 days. The median length of hospital stay was 7 days. The median time to start postoperative chemotherapy was 32 days. There was no major morbidity and mortality.  Conclusion: Modified posterior pelvic exenteration with rectosigmoid anastomosis should be performed when indicated as a part of cytoreduction. In our experience this is a safe and effective procedure to achieve optimal status in advanced ovarian cancer.

Modified posterior pelvic exenteration and rectosigmoid anastomosis for advance epithelial ovarian cancer: A safe cytoreductive procedure